Chapter 49: Case Analysis and Discussion

“I personally believe that the first priority must be an accurate differentiation of syndromes. Only by grasping the syndrome and pathological mechanism can we select the right prescription and ensure effective treatment,” Zhang Jing said earnestly.

“But I chose the prescription based on the ‘Song of Decoctions’ as well, following the disease and syndrome. How could that be wrong?” Huang Biao still looked puzzled.

“Alright, then let me share my understanding of this ‘Song of Decoctions.’ If there’s anything inappropriate, please forgive me, Director Huang,” Zhang Jing began.

“Go ahead, Zhang. Speak frankly—I promise I won’t be angry,” Huang Biao replied solemnly.

“The ‘Song of Decoctions’ compiled by Wang Ang includes over three hundred famous prescriptions, arranged in seven-character poetic verses. Each verse includes the name of the decoction, its ingredients, indications, and modifications according to the syndrome, all succinctly summarized. The rhymes are neat and easy to memorize, making it a valuable reference for beginners in traditional Chinese medicine.”

“However, ultimately, it serves only as a convenient introductory tool for novices. Even mastering it thoroughly only grants a rough understanding of commonly used formulas clinically. In other words, the ‘Song of Decoctions’ at best is a reference book on formulas. Throughout the text, there is hardly any discussion of the principles of syndrome differentiation and treatment.”

“Director Huang, you probably know that if we trace the origins of syndrome differentiation and treatment thinking, the ‘father of formula books’ is Zhang Zhongjing’s Treatise on Cold Damage.”

Huang Biao nodded vigorously, admiration clear on his face. “Hearing you speak is worth more than ten years of reading. The younger generation is truly formidable!”

“Director Huang, you flatter me. I’ve just started clinical practice, while you have nearly forty years of rich experience. I still have much to learn from you,” Zhang Jing thought sincerely.

“Zhang... no, Dr. Zhang, I’m hardly qualified to teach you. To be honest, I came here sincerely to seek your guidance. I hope you won’t hold past misunderstandings against me or treat me like some old fool,” Huang Biao suddenly stood up and said respectfully.

Zhang Jing also rose quickly. “Director Huang, you are a senior expert, yet you’re so courteous to a young doctor like me. How could I dare to accept such praise?”

“In our line of work, age doesn’t matter. Whoever has real skill can be a teacher. Take Ye Tianshi, the famous Qing dynasty physician, for example—he humbly apprenticed under seventeen masters before becoming a great expert in warm diseases. He didn’t care whether his teachers were young or old; his only criterion was genuine skill.”

Seeing the eager look in Huang Biao’s eyes, Zhang Jing felt a sense of déjà vu.

After a moment’s reflection, he recalled that just a few days ago, Wang Sen had looked at him with the very same expression when he sought apprenticeship.

Could it be that Huang Biao also intended to take him as a master?

Otherwise, why would he suddenly change how he addressed Zhang Jing, just like Wang Sen did?

But how could that be?

Huang Biao, a venerable traditional Chinese medicine doctor with nearly forty years of clinical experience, who usually held an air of disdain toward others—

Could it be that merely curing his nephew’s prostate problem made him decide to reform and return to the true path of Chinese medicine?

That would be far too sudden!

Seeing that Zhang Jing remained silent, Huang Biao thought he was unwilling, so he sighed gloomily, “Ah, fine then, Dr. Zhang, let’s just pretend I never said anything. I know you probably think I’m an old fool who wouldn’t understand anyway.”

With that, he was about to turn and leave.

Zhang Jing hurriedly called out, “Please wait, Director Huang, have a seat first.”

Huang Biao looked at him blankly but slowly returned to his chair.

“Director Huang, you completely misunderstood me. I was just trying to recall where we left off in our discussion,” Zhang Jing told a white lie to ease the awkwardness.

“Indeed,” Huang Biao believed him and lightly tapped his forehead. “I forgot too. It’s my fault for dragging the topic so far off.”

“Well then, shall I first explain my syndrome differentiation?” Zhang Jing suggested.

“Good, good,” Huang Biao replied eagerly.

“The patient’s tongue body is pale, with a white, greasy, slippery coating. There’s no obvious stasis under the tongue. The left pulse is wiry and slippery at the guan position, while the right pulse is deep, wiry, and weak. Coupled with the inquiry, my diagnosis is a combined Taiyin-Shaoyin-Shaoyang syndrome, characterized by yang deficiency with damp stagnation.”

“Pale tongue body with white, greasy coating?” Huang Biao suddenly inhaled sharply, puzzled. “How could the tongue be like that? I clearly remember it was yellow and greasy yesterday.”

Zhang Jing hadn’t witnessed the condition yesterday and dared not make a definite assertion. But generally, the tongue body color doesn’t change quickly, and yellow greasy coating is unlikely since Xiaoguizi’s condition involves yang deficiency.

Thus, the most likely explanation is that Huang Biao did not examine the tongue carefully yesterday.

After all, as a veteran doctor with decades of experience, he should be able to distinguish between red and pale tongues.

“Perhaps the patient ate or drank something colored before your examination yesterday, causing the coating to be stained,” Zhang Jing offered him a way to save face.

Then he continued his reasoning: “Moreover, the patient’s right pulse is evidently weak, indicating yang deficiency, which matches the pale tongue.”

“Pulse diagnosis is not my strength, and I didn’t take the pulse well yesterday. But Xiaoguizi looks so robust and works on a construction site every day. How could he have yang deficiency?” Huang Biao questioned again.

“Appearance alone isn’t enough,” Zhang Jing responded. “True, the patient is physically strong, but that only shows he inherited good constitution from his parents. And Director Huang, you yourself look as vigorous as ever,” he added with a touch of humor.

Huang Biao nodded thoughtfully and smiled. “That’s true. The men in my family have been sturdy for generations, but our hair turned white early. You could say we’re strong outside but weak inside.”

“I saw that your nephew’s medical record states he’s single. He probably hasn’t married yet, right?” Zhang Jing asked.

“That’s right. It’s mainly because it’s hard to find a wife. Xiaoguizi works on a construction site with low education and income, making it even harder,” Huang Biao replied.

Zhang Jing nodded slightly. “Therefore, I speculate his yang deficiency might be due to excessive postnatal consumption.”

“Postnatal? You mean overwork from sexual activity? But he doesn’t even have a girlfriend and probably can’t afford such places. How could that be?” Huang Biao still found it hard to understand.

“Precisely because he has no girlfriend, he’s more likely to lack restraint. After all, he’s a young man full of vital energy,” Zhang Jing explained more plainly.

“Oh... oh... oh...” Huang Biao suddenly realized, grinding his teeth in frustration. “That kid! I need to give him a good talking-to when I get back! So this prostate problem is all his own doing.”

“Director Huang, it’s just a speculation. There’s no need for a big fuss or to blame him. Everyone has been young once, and such behavior is normal,” Zhang Jing said.

Then he shifted the topic: “I actually think you could advise him to find a partner soon. It doesn’t have to be someone perfect; what matters most is having a steady companion to share life with.”

“Yes, yes, Dr. Zhang, you’re absolutely right! I’ll talk to his parents about it,” Huang Biao agreed.

After speaking, he suddenly drew a blank. “Eh! Where were we just now?”

Zhang Jing smiled faintly, about to continue, when—

“Knock, knock, knock...”

The door to the consultation room suddenly sounded.

Huang Biao quickly stood up. “Dr. Zhang, a patient has come for your consultation. I won’t disturb you any longer. I’ll come back to seek your advice when I have time.”

With that, he turned to open the door.